Health care providers and payers have been subject to a flurry of developments at the federal level in recent weeks. Considering that health care represents almost 18% of the U.S. gross domestic product, this was perhaps...more
4/10/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Executive Orders ,
Final Rules ,
Healthcare Reform ,
Involuntary Reduction in Force ,
Medical Research ,
Medicare ,
Medicare Advantage ,
Medicare Part D ,
OIG ,
Prescription Drugs ,
Proposed Rules ,
Regulatory Reform ,
Trump Administration
The Office of Inspector General at the U.S. Department of Health and Human Services (OIG) recently followed up on a 2023 commitment to supplement its General Compliance Program Guidance (GCPG) by publishing its first...more
12/5/2024
/ Compliance ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Healthcare Facilities ,
Medicaid ,
Medicare ,
New Guidance ,
Nursing Homes ,
OIG ,
Risk Management ,
Skilled Nursing Facility
In what it describes as a “First-of-its-Kind Healthcare Generative AI Investigation”, the Texas Attorney General (AGO) recently reached a settlement agreement with an artificial intelligence (AI) healthcare technology...more
11/6/2024
/ Artificial Intelligence ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Criminal Investigations ,
Department of Justice (DOJ) ,
False Billing ,
False Claims Act (FCA) ,
False Statements ,
Health Care Providers ,
Health Technology ,
Hospitals ,
Medicare Advantage Organizations (MAOs) ,
Mental Health ,
Proposed Legislation ,
Regulatory Oversight ,
Settlement ,
State Attorneys General ,
Unfair or Deceptive Trade Practices
In early May 2024, the University of Pittsburgh Medical Center (UPMC) agreed to pay $38 million to resolve a False Claims Act case based on alleged Stark Law violations. The size of the settlement in United States ex rel. J....more
6/4/2024
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
Fair Market Value ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Patient Referrals ,
Physicians ,
Relators ,
Settlement ,
Stark Law
On October 6, 2023, the Office of Inspector General at the U.S. Department of Health and Human Services (OIG) released brand new “General Compliance Program Guidance” to assist health care providers, entities, and other...more
11/14/2023
/ 21st Century Cures Act ,
Anti-Kickback Statute ,
Compliance ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Information Blocking Rules ,
New Guidance ,
OIG ,
Quality of Care Standards ,
Stark Law
On February 27, a Minnesota federal court jury ruled in the favor of the U.S. Department of Justice (DOJ) in a False Claims Act (FCA) case based on allegations of Anti-kickback Statute (AKS) violations. The focus of the case...more
3/6/2023
/ Anti-Kickback Statute ,
Bribery ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud ,
Gifts ,
Healthcare Fraud ,
Kickbacks ,
Physicians ,
Whistleblowers
The COVID-19 public health emergency (PHE) will expire at the end of the day on May 11, 2023, which is less than three months away. In the early days of the pandemic, the U.S. Department of Health and Human Services (HHS),...more
2/23/2023
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Physician Fee Schedule ,
Physicians ,
Public Health ,
Public Health Emergency ,
Stark Law
With little warning the Antitrust Division of the U.S. Department of Justice announced on February 3 the withdrawal of three critical pieces of guidance for the health care industry...more
2/13/2023
/ Anti-Competitive ,
Antitrust Division ,
Antitrust Provisions ,
Competition ,
Corporate Practice of Medicine ,
Department of Justice (DOJ) ,
Enforcement Priorities ,
Federal Trade Commission (FTC) ,
Hart-Scott-Rodino Act ,
Health Care Providers ,
Joint Policy Statements ,
Policy Statement
Health care providers began receiving direct deposits into their bank accounts on April 10, 2020 as part of the first disbursement of the $100 billion in provider relief funds allocated under the CARES Act. Providers are...more
The Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”), was signed into law on March 27, 2020. The primary goal of the new law is to stabilize the U.S. economy and create the tools necessary to stem the rising...more
On March 27, 2020, the U.S. Department of Health and Human Services (HHS) approved the waiver request submitted by the Minnesota Department of Human Services (DHS) earlier this month (the “Minnesota Waiver”). In addition to...more
FCC Permits Automatic Calls Under TCPA in Limited Circumstances and OIG Issues Special Fraud Alert Permitting Co-Insurance Waivers for Telehealth Services.
TCPA Guidance Permits Automatic Calls -
The COVID-19 pandemic...more
As a result of the novel Coronavirus pandemic, the Office for Civil Rights (OCR) recently issued several pieces of guidance to help HIPAA covered entities and their business associates to best address how patient information...more
3/20/2020
/ Business Associates ,
Coronavirus/COVID-19 ,
Covered Entities ,
Emergency Response ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Privacy Rule ,
New Guidance ,
OCR ,
PHI ,
Relief Measures ,
State of Emergency ,
Telehealth